Provider Demographics
NPI:1659388304
Name:RENN, MELISSA JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:RENN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OTOE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4640
Mailing Address - Country:US
Mailing Address - Phone:402-328-2794
Mailing Address - Fax:
Practice Address - Street 1:1900 OTOE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4640
Practice Address - Country:US
Practice Address - Phone:402-328-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist